Chorea: Difference between revisions

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== Phenomenological Features ==
== Phenomenological Features ==


*'''Randomness'''
* Randomness
*'''Flowing Quality'''
* Flowing Quality
*'''Parakinesia'''-Patients blend their chorea-induced movements with their own normal movements.
* Parakinesia:Patients blend their chorea-induced movements with their own normal movements.
*'''Motor impersistence'''-the patient is unable to perform sustained motor activities.
* Motor impersistence:the patient is unable to perform sustained motor activities.
*'''Ballism'''-Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
* Ballism:Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
*'''Athetosis'''-Slow writhing movements involving distal limbs sometimes may be facing.
* Athetosis:Slow writhing movements involving distal limbs sometimes may be facing.
*'''Varying velocity of movements'''-quick velocity and low-amplitude movements accompanied by jerks.
* Varying velocity of movements:quick velocity and low-amplitude movements accompanied by jerks.


{{#ev:youtube|RxWEilu-Mf4}}
{{#ev:youtube|RxWEilu-Mf4}}
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Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.Differential diagnoses include:
Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.Differential diagnoses include:


* Huntington disease
*[//m.houseofhawgs.com/Huntington_DiseaseHuntington disease]
* [[Lyme Disease|Lyme disease]]
* [[Lyme Disease|Lyme disease]]
* [[Multiple System Atrophy|Multiple system atrophy]]
* [[Multiple System Atrophy|Multiple system atrophy]]
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Chorea requires a Multidisciplinary Approach to be treated.Feinstein E, Walker R. [https://link.springer.com/article/10.1007/s11940-018-0529-y An update on the treatment of chorea. Current Treatment Options in Neurology]. 2018 Oct;20(10):1-5.
Chorea requires a Multidisciplinary Approach to be treated.Feinstein E, Walker R. [https://link.springer.com/article/10.1007/s11940-018-0529-y An update on the treatment of chorea. Current Treatment Options in Neurology]. 2018 Oct;20(10):1-5.


The team includes
The team includes:


* Psychiatrist
* Psychiatrist
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* Social worker
* Social worker
=== Medical Management ===
=== Medical Management ===
There is no cure for this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specializedcaregiving. Nutrition management is important, due to difficulty swallowing.
There is'''no cure'''for this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specializedcare. Nutrition management is important, due to difficulty swallowing.


1.'''Dopamine-depleting agents'''-Tetrabenazine, Deutetrabenazine, Valbenazine.
1. Dopamine-depleting agents:Tetrabenazine, Deutetrabenazine, Valbenazine.


2.'''Dopamine D2 receptor-blocking agents'''-Haloperidol, Clozapine, Olanzapine.
2. Dopamine D2 receptor-blocking agents:Haloperidol, Clozapine, Olanzapine.


3.'''Anticonvulsants'''-Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.
3. Anticonvulsants:Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.


4.'''Anti-glutamatergic agents'''-Amantadine, Riluzole.
4. Anti-glutamatergic agents:Amantadine, Riluzole.


5.'''Cannabinoids'''-Nabilone.
5. Cannabinoids:Nabilone.


6.'''Deep Brain Stimulation'''
6.[[Deep Brain Stimulation]]


== Physiotherapy Management ==
== Physiotherapy Management ==
The management will be same as ofHuntington's Disease. You can read it[//m.houseofhawgs.com/Huntington_Disease?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#Physiotherapy_Managementhere].
The management will be same as of [//m.houseofhawgs.com/Huntington_Disease?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#Physiotherapy_ManagementHuntington's Disease].


=== Goals of Management ===
=== Goals of Management ===


* Gait re-education
*[[Gait]]re-education
* [[Balance|Balance r]]etraining
* [[BalanceTraining|Balance r]][[Balance Training|etraining]]
* [[Falls|Fall]] prevention/management
* [[Falls|Fall]] prevention/management
* Aerobic capacity
*[[AerobicExercise|Aerobic]]capacity
* Muscle [[Strength and Conditioning|strengthening]]
* Muscle [[Strength and Conditioning|strengthening]]
* [[Wheelchair Assessment|Wheelchair]] prescription and training
* [[Wheelchair Assessment|Wheelchair]] prescription and training

Latest revision as of 12:12, 2 October 2022

Original Editor-Muskan Rastogi Top Contributors-Muskan Rastogi,Lucinda hampton,Chelsea McleneandCindy John-Chu

Introduction[edit|edit source]

Rheumatic chorea

Chorea is defined as "a state of excessive, spontaneous movements, irregularly timed, non-repetitive, randomly distributed and abrupt in character. These movements may vary in severity from restlessness with mild intermittent exaggeration of gesture and expression, fidgeting movements of the hands, unstable dance-like gait to a continuous flow of disabling, violent movements."[1]

  1. The word Chorea has Greek origins meaning "to dance". It has a dance-like appearance due to the random and flowing quality of the movement.
  2. Chorea is a type ofhyperkinetic movement disorder.
  3. The involuntary movements flow from one body area to another which cannot be predicted beforehand.

Etiology[edit|edit source]

Chorea traditionally is described in Huntington disease, however other disorders that can lead to chorea, for example: Spinocerebellarataxiasubtypes;Wilson disease; Sydenham chorea, and structural disease of the basal ganglia. Generally, the root of the pathology is in thebasal ganglia.[1]

They are predominantly of 2 types[2]

  • Acquired Causes
  • Genetic Causes
Acquired Causes of Chorea


Genetic Causes of Chorea


Phenomenological Features[edit|edit source]

  • Randomness
  • Flowing Quality
  • 运动倒错:患者混合chorea-induced movements with their own normal movements.
  • Motor impersistence: the patient is unable to perform sustained motor activities.
  • Ballism: Variant of chorea which shows large-amplitude flinging movements involving proximal extremities.
  • Athetosis: Slow writhing movements involving distal limbs sometimes may be facing.
  • 不同速度的运动:快速度low-amplitude movements accompanied by jerks.[2]

This video displays the dance-like movements performed by a patient.[3]

Diagnosis[edit|edit source]

The phenomenological features mentioned above are observed to make a diagnosis of chorea.

Differential Diagnosis[edit|edit source]

Specific diagnosis can be made on the basis of symptoms/clinical features experienced by the patient.[2]Differential diagnoses include:

Multimodal Management[edit|edit source]

Mutimodal management chorea.jpg

Chorea requires a Multidisciplinary Approach to be treated.[4]

The team includes:

  • Psychiatrist
  • Physical medicine and Rehabilitation Specialist
  • Physical therapist
  • Occupational therapist
  • Speech therapists
  • Geneticist
  • Genetic Counselor
  • Social worker

Medical Management[edit|edit source]

There isno curefor this disease but symptoms can be managed. Importantly an evaluation and creation of a patient's support system is needed. With disease progression, the patient will need specialized care. Nutrition management is important, due to difficulty swallowing.[1]

1. Dopamine-depleting agents: Tetrabenazine, Deutetrabenazine, Valbenazine.

2. Dopamine D2 receptor-blocking agents: Haloperidol, Clozapine, Olanzapine.

3. Anticonvulsants: Valproic acid, Carbamazepine, Benzodiazepines, Levetiracetam.

4. Anti-glutamatergic agents: Amantadine, Riluzole.

5. Cannabinoids: Nabilone.

6.Deep Brain Stimulation

Physiotherapy Management[edit|edit source]

The management will be same as ofHuntington's Disease.

Goals of Management[edit|edit source]

References[edit|edit source]

  1. ↑1.01.11.21.3Merical B, Sánchez-Manso JC. Chorea. Available:https://www.ncbi.nlm.nih.gov/books/NBK430923/#!po=15.0000(accessed 19.9.2022)
  2. ↑2.02.12.2Termsarasab P.Chorea. CONTINUUM: Lifelong Learning in Neurology. 2019 Aug 1;25(4):1001-35.
  3. ↑neurosigns.org. Chorea. Available fromhttps://www.youtube.com/watch?v=RxWEilu-Mf4&ab_channel=neurosigns.org
  4. ↑Feinstein E, Walker R.An update on the treatment of chorea. Current Treatment Options in Neurology. 2018 Oct;20(10):1-5.
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